Sacropelvic resection and intraoperative electron irradiation in the management of recurrent anorectal cancer

PURPOSE: To provide local control and palliation of pain, a multimodality approach, including external beam radiation therapy, surgical resection, and intraoperative electron irradiation (IOERT), has been used for patients with locally advanced anal or recurrent rectal cancers involving the sacrum. METHODS: Sixteen consecutive patients (11 males; 5 females; ages, 44-76) underwent surgical exploration, sacrectomy, and IOERT, between 1990 and 1994. RESULTS: Proximal extent of resection was S2-3 in four patients, S3-4 in five, and S4-5 in five. Two patients had resection of the anterior table of the sacrum. Margins were clear in 11, close in 3, and microscopically involved in 2 patients. Operative times ranged from 6 to 17 (median, 12.5) hours, and blood loss ranged from 300 to 12,600 (median, 3,350) ml. No operative deaths resulted. Major postoperative complications occurred in eight patients (50 percent): posterior wound infections and dehiscence, urinary leak, and ileal fistula. Five (31 percent) and 3 (19 percent) patients developed no or minor complications, respectively. Intensive Care Unit stay was one night for all patients, and overall hospital stay ringed from 11 to 30 (median, 16.5) days. Follow-up was available on all 16 patients, Kaplan-Meier survival was 68 percent at one year and 48 percent at two years. At the time of analysis, 9 of 16 patients were alive. Of the nine alive patients who responded to a questionnaire, eight reported a reduction in pain and improved quality of life postoperatively. CONCLUSIONS: Sacropelvic resection, in conjunction with IOERT, provides palliation and offers potential for cure in patients with locally advanced or recurrent anorectal cancer.